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Eclampsia

Overview

Eclampsia is defined as the new onset of <a href="https://merisehat.pk/disease/seizures">seizures</a> in a woman with preeclampsia<a href="#accordion">[1]</a>. 
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Preeclampsia and eclampsia are among four disorders that fall under hypertensive disorders of pregnancy. The other three include chronic hypertension, gestational <a href="https://merisehat.pk/disease/hypertension-57">hypertension</a>, and chronic hypertension superimposed on preeclampsia. These hypertensive disorders globally affect an estimated 10% of all pregnancies<a href="#accordion">[1]</a>. Preeclampsia and eclampsia are responsible for half of these cases<a href="#accordion">[2]</a>.

Preeclampsia is a disorder marked by high blood pressure and signs of organ damage in pregnant women. If left untreated, preeclampsia can escalate to eclampsia, putting both the mother and the fetus at serious risk. In Pakistan, the incidence of preeclampsia is as high as 5%<a href="#accordion">[4]</a>.

Eclampsia is an obstetric complication that arises during pregnancy, usually after 20 weeks of gestation, and is characterized by seizures in a woman who previously had preeclampsia. Eclamptic seizures can also occur postpartum.

Eclampsia is a prominent cause of maternal mortality and morbidity, affecting women across developed and developing nations. A recent study assessed the incidence of eclampsia and its related complications across 10 low- and middle-income regions. As per the data collected from across Africa, India, and Haiti, approximately 0.5% of women had eclampsia, and 6.9% of them died as a result<a href="#accordion">[3]</a>. 
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Note: Eclampsia represents a life-threatening medical emergency, with significant implications for maternal health worldwide. 
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Eclampsia and preeclampsia are two related but distinct medical conditions that occur during pregnancy. Preeclampsia is a condition characterized by high blood pressure and signs of organ damage, typically after 20 weeks of gestation. It may present with symptoms like swelling, headaches, and vision changes. If left untreated, preeclampsia can progress to eclampsia, which is a severe and life-threatening complication. 
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Eclampsia is marked by the occurrence of seizures in a woman with preeclampsia or during the postpartum period. While both disorders involve high blood pressure and can share symptoms, the defining feature of eclampsia is the presence of seizures. Both conditions require immediate medical attention and management to safeguard the health of the mother and the baby. Early detection through regular prenatal care is vital in preventing the escalation from preeclampsia to eclampsia and ensuring a safe pregnancy outcome. 
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Eclampsia can be categorized into three primary types based on the timing of onset: 
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<ul>
	<li>Antepartum Eclampsia - This type occurs before childbirth, usually during the third trimester of pregnancy. It is characterized by the onset of seizures in a woman who previously had preeclampsia. The seizures in antepartum eclampsia can pose serious risks to both the mother and the fetus. 
	&nbsp;</li>
	<li>Intrapartum Eclampsia - Intrapartum eclampsia occurs during childbirth, typically during labor or delivery. It is a rare but severe complication in women who develop preeclampsia during pregnancy and experience seizures during the process of giving birth. The occurrence of seizures during labor can complicate the delivery process and necessitate immediate medical intervention. 
	&nbsp;</li>
	<li>Postpartum Eclampsia - Postpartum eclampsia occurs after childbirth, typically within the first 48 hours following delivery. It is a rare but life-threatening condition that can affect women who had preeclampsia during pregnancy. The risk of eclampsia persists in the immediate postpartum period, and prompt medical attention is crucial to manage seizures and prevent complications. 
	&nbsp;</li>
</ul>

Note: All three subtypes of eclampsia are considered medical emergencies that require immediate attention and appropriate treatment to ensure the safety and well-being of the mother and the newborn. Women with a history of preeclampsia should be closely monitored during pregnancy, labor, and the postpartum period to promptly detect and manage eclamptic seizures. 
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Signs and Symptoms

Eclampsia is a serious and life-threatening complication of pregnancy that can be preceded by symptoms of preeclampsia. It is crucial to recognize the warning signs to seek immediate medical attention. While some symptoms may overlap with preeclampsia, eclampsia is characterized by the onset of seizures.

Here are the common signs and symptoms of both preeclampsia and eclampsia: 
&nbsp;

<ul>
	<li>Elevated blood pressure</li>
	<li>Swelling in the face or hands</li>
	<li>Severe or persistent headaches</li>
	<li>Rapid and unexplained weight gain during pregnancy</li>
	<li>Nausea and vomiting</li>
	<li>Blurry vision, seeing spots, or temporary loss of vision</li>
	<li>Reduced urine output or difficulty in urinating</li>
	<li>Pain in the upper right abdomen 
	&nbsp;</li>
</ul>

Additional Symptoms Of Eclampsia

<ul>
	<li>Generalized tonic-clonic seizures</li>
	<li>Loss of consciousness</li>
	<li>Agitation and confusion 
	&nbsp;</li>
</ul>

Warning Signs Before Seizure In Eclampsia

<ul>
	<li>Severe headache</li>
	<li>Shortness of breath or breathing difficulties</li>
	<li>Nausea or vomiting</li>
	<li>Reduced or infrequent urination</li>
	<li>Pain in the upper right abdomen</li>
	<li>Blurred vision, double vision, or vision loss</li>
	<li>Swelling of hands, face, or ankles 
	&nbsp;</li>
</ul>

Pregnant individuals need to be aware of these symptoms and seek immediate medical evaluation if they experience any of them. Proper prenatal care and early detection are crucial to managing and preventing the progression of preeclampsia to eclampsia, ensuring the well-being of both the mother and the baby. 
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Causes

While the precise cause of eclampsia remains elusive, researchers attribute its development to various interrelated factors<a href="#accordion">[1][2]</a>: 
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<ul>
	<li>Abnormal Placental Development: Issues with the placenta, such as inadequate blood flow to the uterus, may trigger the condition.</li>
	<li>Genetic Factors: A family history of preeclampsia or eclampsia can increase a woman&#39;s predisposition to the condition.</li>
	<li>Immune Response: An abnormal immune reaction to the developing placenta could contribute to eclampsia.</li>
	<li>Blood Vessel Dysfunction: Impairment in blood vessel dilation and constriction may play a role in the development of hypertension and subsequent seizures.</li>
	<li>Endothelial Cell Dysfunction: Damage to endothelial cells that line blood vessels can lead to vascular abnormalities, including reduced blood flow and increased permeability.</li>
	<li>Inflammation: Inflammation within the body, particularly in the vascular system, has been associated with preeclampsia and eclampsia. 
	&nbsp;</li>
</ul>

Early detection is vital for managing eclampsia effectively. Regular prenatal care plays a crucial role in identifying and monitoring high-risk pregnancies. Routine blood pressure measurements and urine tests for proteinuria are essential components of prenatal screenings to detect preeclampsia early on and prevent its progression to eclampsia. 
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Diagnosis

Healthcare professionals diagnose eclampsia by carefully evaluating the patient&#39;s medical history and conducting several diagnostic tests. If a patient has a previous diagnosis of preeclampsia or a history of the condition, the doctor will order tests to determine if preeclampsia has recurred or worsened. For patients without a previous diagnosis of preeclampsia, the doctor will order tests to investigate the cause of the seizures and rule out other potential conditions. The diagnostic tests include: 
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<ul>
	<li>Blood Tests: Various blood tests, such as complete blood count and platelet count, are performed to assess red blood cell count, blood clotting, and kidney and liver function. 
	&nbsp;</li>
	<li>Creatinine Test: This test measures the level of creatinine, a waste product produced by muscles, in the blood. Elevated creatinine levels may indicate kidney damage, a common feature of preeclampsia. 
	&nbsp;</li>
	<li>Urine Tests: Urine tests are conducted to check for the presence of protein and assess its excretion rate. High levels of protein in the urine (proteinuria) are often associated with preeclampsia. 
	&nbsp;</li>
</ul>

The diagnosis of eclampsia is primarily based on the presence of a seizure. To confirm eclampsia, healthcare providers perform a thorough physical examination, order blood work, and regularly monitor blood pressure. Additional urine tests are conducted to detect increased protein levels in the urine. As eclampsia is a severe complication, it is essential for healthcare professionals to closely monitor the condition of the fetus through ultrasound and check its heart rate, movement, size, and other factors to ensure it is tolerating the pregnancy well. Prompt and accurate diagnosis is crucial for timely intervention and the safety of both the mother and the baby. 
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Treatment

The treatment and management of patients with eclampsia involve immediate and aggressive intervention to control seizures, stabilize blood pressure, and ensure the well-being of both the mother and the fetus<a href="#accordion">[1][2]</a>. 
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1. Seizure Management: Eclamptic seizures are a medical emergency and require prompt attention. The first-line treatment for eclamptic seizures is magnesium sulfate. A loading dose of 4 to 6 grams is administered intravenously over 15 to 20 minutes, followed by a maintenance dose of 2 grams per hour. Other antiepileptic medications, such as diazepam or phenytoin, may be used for refractory seizures that do not respond to magnesium. 
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2. Airway Management: During seizures, the patient&#39;s airway is secured to prevent aspiration. Patients are placed on their left side, and suction is applied to help with oral secretions. Airway adjuncts should be readily available in case intubation is required. 
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3. Blood Pressure Control: Managing high blood pressure is essential in patients with eclampsia. Antihypertensive medications, including labetalol, nifedipine, and hydralazine, are used to control blood pressure in pregnant women with preeclampsia. The choice of medication and dosing depends on the individual patient&#39;s condition. 
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4. Delivery Planning: For women with severe preeclampsia who are greater than 34 weeks gestation and are unstable, delivery should be considered once the mother is stabilized. Corticosteroids may be given to women with fetal gestation of less than 34 weeks to aid in lung maturation if time permits. Delivery of the fetus is the definitive treatment for preeclampsia/eclampsia. 
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5. Postpartum Care: Blood pressure control is essential postpartum, as the risk for eclampsia remains high during the 48 hours after birth. Magnesium sulfate is continued for 12 to 24 hours post-delivery. 
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The treatment and management of eclampsia require a multidisciplinary approach involving obstetricians, anesthesiologists, and nurses to provide immediate and comprehensive care. Early recognition and intervention are critical in preventing mortality and ensuring the best possible outcome for both the mother and the baby. Regular monitoring and close follow-up are necessary to detect and manage any potential complications. 
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Eclampsia can lead to severe and potentially life-threatening complications for both the mother and the fetus, including: 
&nbsp;

<ul>
	<li>Prolonged or recurrent seizures leading to brain damage</li>
	<li>Organ failure, particularly involving the liver and kidneys</li>
	<li>Placental abruption, which can jeopardize fetal oxygen supply</li>
	<li>Preterm birth, leading to potential neonatal complications</li>
	<li>Low birth weight</li>
	<li>Fetal distress</li>
	<li>Maternal mortality 
	&nbsp;</li>
</ul>

Several risk factors increase the likelihood of developing eclampsia, including: 
&nbsp;

<ul>
	<li>Previous history of preeclampsia or eclampsia in a previous pregnancy</li>
	<li>Primigravida (first-time pregnancy) or multiparity (multiple pregnancies)</li>
	<li>Chronic hypertension or pre-existing medical conditions such as diabetes or kidney disease</li>
	<li>Obesity or excessive weight gain during pregnancy</li>
	<li>Adolescents and women over 40 years of age</li>
	<li>Family history of preeclampsia/eclampsia 
	&nbsp;</li>
</ul>

While eclampsia cannot always be entirely prevented, certain measures can reduce its risk and severity, including: 
&nbsp;

<ul>
	<li>Regular prenatal care and screenings, especially for women at higher risk</li>
	<li>Maintaining a healthy lifestyle during pregnancy</li>
	<li>Monitoring and managing chronic health conditions before and during pregnancy</li>
	<li>Complying with healthcare provider&#39;s recommendations for medications and supplements during pregnancy</li>
	<li>Attending all prenatal check-ups as scheduled and being vigilant for any warning signs of preeclampsia or eclampsia 
	&nbsp;</li>
</ul>

Recently, researchers from the Stanford School of Medicine made a significant discovery in diagnosing preeclampsia. They have discovered biomarkers in the blood and urine of women with preeclampsia that can likely help predict preeclampsia months before symptoms manifest<a href="#accordion">[6]</a>.

Currently, preeclampsia can only be diagnosed in the second half of pregnancy, but with predictive testing, better pregnancy monitoring and more effective treatments can be developed.

The researchers collected biological samples from pregnant women, analyzing changes in various biological signals to identify a small set of predictive signals. Conducting a urine test early in pregnancy was found to more likely predict preeclampsia. This early prediction can lead to closer monitoring of pregnant women, early symptom identification, and reduced risk of maternal complications and premature births. The study also suggests that low-dose aspirin starting early in pregnancy may lower preeclampsia rates in high-risk women. 
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Key Points

<ul>
	<li>Eclampsia is a severe complication of pregnancy characterized by the onset of seizures in a woman who previously had preeclampsia.</li>
	<li>Eclampsia typically occurs after 20 weeks of gestation, during the third trimester of pregnancy, or within 48 hours following childbirth.</li>
	<li>Common signs include seizures, high blood pressure, edema (swelling), proteinuria (protein in urine), severe headaches, and visual disturbances.</li>
	<li>The exact cause is not fully understood, but it is linked to abnormal placental development, immune responses, genetic factors, and blood vessel dysfunction.</li>
	<li>Regular prenatal care involves blood pressure measurements and urine tests to detect preeclampsia early and prevent its progression to eclampsia.</li>
	<li>Eclampsia is diagnosed when seizures occur in a woman with preeclampsia or during the postpartum period. Additional tests are performed to confirm the diagnosis.</li>
	<li>Immediate medical intervention is critical. Magnesium sulfate is the first-line treatment to prevent and control seizures. Antihypertensive medications may also be used to manage high blood pressure.</li>
	<li>Eclampsia can lead to severe complications, including brain damage from seizures, organ failure, placental abruption, preterm birth, low birth weight, and maternal mortality.</li>
	<li>Primigravida, multiple pregnancies, chronic hypertension, obesity, age extremes (adolescents and women over 40), and family history increase the risk of eclampsia.</li>
	<li>While not always preventable, regular prenatal care, a healthy lifestyle, and managing pre-existing conditions can reduce the risk and severity of eclampsia. 
	&nbsp;</li>
</ul>

[1] Magley M, Hinson MR. Eclampsia. [Updated 2023 Jan 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

[2] Eclampsia. Medscape.

[3] Vousden N, Lawley E, Seed PT, et al. Incidence of eclampsia and related complications across 10 low- and middle-resource geographical regions: Secondary analysis of a cluster randomized controlled trial. PLoS Med. 2019;16(3):e1002775. Published 2019 Mar 29. doi:10.1371/journal.pmed.1002775

[4] Khan B, Allah Yar R, Khakwani AK, Karim S, Arslan Ali H. Preeclampsia Incidence and Its Maternal and Neonatal Outcomes With Associated Risk Factors. Cureus. 2022;14(11):e31143. Published 2022 Nov 6. doi:10.7759/cureus.31143

[5] López-Llera M. Main clinical types and subtypes of eclampsia. Am J Obstet Gynecol. 1992;166(1 Pt 1):4-9. doi:10.1016/0002-9378(92)91816-s

[6] Marić I, Contrepois K, Moufarrej MN, et al. Early prediction and longitudinal modeling of preeclampsia from multiomics. Patterns. 2022;3(12):100655. doi:10.1016/j.patter.2022.100655